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NPI Code Detail

MEDICARE: MR. NICHOLAS MICHAEL JESTER

MEDICARE: MR. NICHOLAS MICHAEL JESTER
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YA0400XAddiction (Substance Use Disorder) Counselor

General Provider Information

NPI Number : 1275152324
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. NICHOLAS MICHAEL JESTER
Provider Business Mailing Address
First Line : 1820 SCENIC AVE
Second Line :
City : BERKELEY
State : CA
Zip : 94709-1324
Country : US
Telephone Number : 105-487-2705
Fax Number :
Provider Business Practice Location Address
First Line : 1610 MILVIA ST APT 2
Second Line :
City : BERKELEY
State : CA
Zip : 94709-2047
Country : US
Telephone Number : 510-362-4378
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/09/2020
Last Update Date : 04/09/2020

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